Author: mh/ktg

Related content: Contrast Dose Management, Workflow, Quality Assurance

Make Dose Tracking Sustainable

To gain maximum benefit from dose tracking, the staff must actively use it – not only when authorities ask for the dose report.

Session Topic: EU 4 European CT dose repository
Session Date: Friday, March 3rd 2017
Presentation Code: A-475
Presentation Title: How do dose tracking tools change the practice of radiologists?
Name of Speaker: Federica Zanca, University of Leuven/Belgium
Congress: ECR 2017, Vienna

“Some dose tracking systems are actively used by the staff, and others are only consulted when the federal agency asks for dose reports,” said Federica Zanca, University of Leuven, Belgium. She explained how to install a dose tracking system in a clinical radiological setting and described exemplary outcomes.

Installation of a dose tracking system

To install a dose tracking system, a dedicated server is necessary to which all scanners get connected. Validation of the incoming data is crucial and time-consuming. The interface must be user-friendly for radiographers and radiologists. Last but not least, setting up a systematic dose reporting is mandatory. “It is a big effort to get all this done”, said Zanca.

To make it a sustainable project and to create a tool for daily routine, you need a dose management team with a clear vision and well-defined processes. Protocol optimization is an obligatory process when launching a dose tracking system. An effective dose tracking provides multiple opportunities for staff education – but also requires education to raise awareness for the radiation dose issue, to establish the newly developed processes, and to monitor adherence to standards and targets.

Benefits from dose tracking

Ruth Nicol et al. (Br J Radiol 2016; 89: 20150617) from Coventry integrated their dose tracking system with the RIS. This allowed them to filter examinations by the clinical indication codes. They were able to show differences in mean dose length products (DLP) across their various scanners. They identified significant variation in their protocol parameters.

Heilmaier et al. (Eur Radiol. 2017 Mar;27(3):1021-1031) installed a permanently active monitor with dose information in the examination room. The staff is now able to look up dose data in real-time and to justify dose outliers directly at the site. For example, they discovered that patient centering in the scanner was not optimal in some cases. The lesson learned was to better control this and to use lateral scout images for exposure control.

Three institutions from Belgium (source was not mentioned) benchmarked their pediatric CT examinations. All three hospitals were clearly below the national dose reference levels (DRL); however, one hospital showed significantly less variability in their pediatric CT dose values and lower overall dose. “The staff of this department was actively using their dose tracking system,” explained Zanca. The lesson learned was: We are doing well, but we can do even better. Furthermore, the participating centers discovered that adult CT protocols were used in pediatric patients more often than they had expected and what would have been appropriate. In one center, the mean CT scan ranges for pediatric patients were higher than for adult patients. The reason: A new CT scanner had been installed; its automatic scan length selection had not been adjusted to the actual scanner use.

Conclusion

“Dose tracking tools help to comply with legislation and are efficient methods of standardizing radiation safety procedures,” concluded Zanca. They enable the radiology staff to evaluate their actual imaging practices and to become actively engaged in a safe environment.